Journal of Community Nursing - page 53

JCN
2013,Vol 27, No 4
53
WOUND CARE
Table 1:
Categories of pressure ulcer (EPUAP and NPUAP, 2009)
Category 1
Intact skin with non-blanchable redness of a localised area usually over a bony prominence.
Darkly pigmented skin may not have visible blanching; its colour may differ from the
surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to
adjacent tissue. Category I may be difficult to detect in individuals with dark skin tones. May
indicate‘at-risk’persons.
Category 2
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound
bed, without slough. May also present as an intact or open/ruptured serum-filled or sero-
sanginous filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising*.
This category should not be used to describe skin tears, tape burns, incontinence-associated
dermatitis, maceration or excoriation.
*Bruising indicates deep tissue injury.
Category 3
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are
not exposed. Slough may be present but does not obscure the depth of tissue loss. May
include undermining and tunnelling. The depth of a Category/Stage III pressure ulcer varies
by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have
(adipose) subcutaneous tissue and Category/Stage III ulcers can be shallow. In contrast,
areas of significant adiposity can develop extremely deep Category/Stage III pressure ulcers.
Bone/tendon is not visible or directly palpable.
Category 4
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are
not exposed. Slough may be present but does not obscure the depth of tissue loss. May
include undermining and tunneling. The depth of a Category/Stage III pressure ulcer varies
by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have
(adipose) subcutaneous tissue and Category/Stage III ulcers can be shallow. In contrast,
areas of significant adiposity can develop extremely deep Category/Stage III pressure ulcers.
Bone/tendon is not visible or directly palpable.
which is vulnerable to pressure
damage. As they can be washed
with soap and water, they can be
reused on the same patient for as
long as required, making them cost-
effective as part of a holistic care
plan to prevent pressure ulceration.
EVALUATION
This article describes the interim
results of a four-week evaluation of
KerraPro Heel pressure-reducing
pads (
Figure 1
), which was carried
out on five care home residents,
with category 1 pressure damage to
the heal, to:
Determine the pad’s ability to
reduce pressure
Prevent further pressure damage
Improve viability of damaged skin.
In addition, the performance of
KerraPro Heel pressure-reducing pads
was compared with the pressure-
relieving product usually used.
METHODS
The patients who were recruited
had a Waterlow score of 15 or more
/
downloads/Waterlow%20Score%20
Card-front.pdf), no greater than
category 1 pressure damage to
the heel(s)
(Table 1)
, no signs of
infection and were able to give
informed consent to participate in
the evaluation.
Once enrolled, subjects were
assessed and their most damaged
heel was treated for four weeks
with a KerraPro Heel pressure-
reducing pad (the same pad was
used throughout the four-week
evaluation, being washed, dried and
reused), while the other heel was
treated with usual pressure relief.
Skin condition was assessed
on enrolment, then once a week
to check for improvement/
deterioration in skin integrity and
the presence of erythema and/or
palpable oedema, and to ensure
that the products were being used
and positioned correctly.
High frequency diagnostic
ultrasound scans were performed at
the start and completion of the
evaluation (at the end of week four)
to determine the condition of the
damaged skin and capture any
subclinical changes, such as the
development of oedema (observed
as red pixellation) as a result of
inflammatory processes relating to
category 1 pressure damage, and to
detect any subsequent improvement/
deterioration of tissue.
In addition to imaging of the
damaged area, ultrasound scans of
undamaged normal skin adjacent to
the site of injury were performed to
act as a control (
Figure 2
) and give a
measure of how far from normal the
tissues were at the start of the
evaluation and how they had
progressed back towards the
uninjured state as the study advanced.
Each scan was analysed
using a form of pixel distribution
analysis, where pixels below a
certain intensity were classed as
low echogenic pixels (LEP). The
ratio of LEP to total pixel count
(TP; LEP:TP) reflected changes in
dermal water content as a proxy
for determining inflammation
levels in the dermis, enabling
Figure 1.
KerraPro
®
Heel pressure-reducing pad in situ.
1...,43,44,45,46,47,48,49,50,51,52 54,55,56,57,58,59,60,61,62,63,...116